Key result
General anesthetics show conflicting evidence for pediatric neurotoxicity and warrant no changes to clinical practice.
Why the study?
Animal studies have shown general anesthetics cause neuroapoptosis and long-term neurocognitive deficits in immature brains, but effects in human neurons remain uncertain with conflicting observational study results.
Does exposure to general anesthetics cause neurocognitive impairment later in life in children?
Does exposure to general anesthetics cause neurocognitive impairment later in life in children?
Current evidence on anesthesia-related neurotoxicity in children is conflicting and insufficient to warrant changes in clinical practice or withholding necessary surgeries.
Introduction: Animal studies (including in nonhuman primates) have shown that most general anesthetics cause enhanced neuroapoptosis in the immature brain with subsequent long-term neurocognitive deficits later in life. Whether human neurons are equally affected is yet unknown, but a final answer to this issue is still pending. To date, most human studies within the field are of observational nature and the results are conflicting. Some studies indicate an association between exposure to anesthesia and surgery while others do not. Objective: This review summarizes results from preclinical and observational studies. Controversies and challenges regarding the interpretation of these results are presented. Crucial aspects of neurocognitive safety during pediatric anesthesia and surgery are highlighted. International initiatives aiming to improve the safe conductance of pediatric anesthesia are introduced. Conclusion: So far, anesthesia-related neurotoxicity in humans remains an area of concern but it cannot be completely excluded. Clinical practice should not be changed until there are definite proofs that anesthetic exposure causes neurocognitive impairment later in life. Withholding necessary and timely surgeries as a consequence of any such concerns could result in worse harm. Focus of current research should also be redirected to include other factors, than merely anesthetics and surgery, that influence the neurocognitive safety of children perioperatively.
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Clausen et al. (2015) conducted a review in Anesthesia-related neurotoxicity in children. General anesthetics was evaluated on Neurocognitive impairment later in life. Current evidence regarding anesthesia-related neurotoxicity in children remains conflicting, and clinical practice should not be changed until there is definite proof of neurocognitive impairment.
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